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Prognostic Factors for Survival in Adult Patients With Cerebral Low-Grade Glioma

From the European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium; University Hospital Rotterdam–Daniel Den Hoed Kliniek, Rotterdam; Westeinde Ziekenhuis, Den Haag; and Vrije Universiteit Hospital, Amsterdam, the Netherlands; National Institute of Neurosurgery, Budapest, Hungary; Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris; and Centre Hospitalier Régional de Grenoble–La Tronche, Grenoble, France.

Address reprint requests to Francesco Pignatti, MD, MSc, European Agency for the Evaluation of Medicinal Products, 7 Westferry Circus, Canary Wharf, London E14 4HB, United Kingdom; email: francesco .pignatti{at}emea.eu.int

PURPOSE: To identify prognostic factors for survival in adult patients with cerebral low-grade glioma (LGG), to derive a prognostic scoring system, and to validate results using an independent data set.

PATIENTS AND METHODS: European Organization for Research and Treatment of Cancer (EORTC) trial 22844 and EORTC trial 22845 are the largest phase III trials ever carried out in adult patients with LGG. The trials were designed to investigate the dosage and timing of postoperative radiotherapy in LGG. Cox analysis was performed on 322 patients from EORTC trial 22844 (construction set), and the results were validated on 288 patients from trial 22845 (validation set). Patients with pilocytic astrocytomas were excluded from this prognostic factor analysis.

RESULTS: Multivariate analysis on the construction set showed that age 40 years, astrocytoma histology subtype, largest diameter of the tumor 6 cm, tumor crossing the midline, and presence of neurologic deficit before surgery were unfavorable prognostic factors for survival. The total number of unfavorable factors present can be used to determine the prognostic score. Presence of up to two of these factors identifies the low-risk group, whereas a higher score identifies high-risk patients. The validity of the multivariate model and of the scoring system was confirmed in the validation set.

CONCLUSION: In adult patients with LGG, older age, astrocytoma histology, presence of neurologic deficits before surgery, largest tumor diameter, and tumor crossing the midline were important prognostic factors for survival. These factors can be used to identify low-risk and high-risk patients.

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